HomeMy WebLinkAbout3809 Big Dipper Dr - Applications/Water Heater - 11/29/2016;Panning, Deiielopjlent &
281 N. College Ave P.O. Bo�.'. 5;111:
Fort Collins, CO 805211
Phone 970-416-2740 Fai, 224 613
'It apply). E'l Ai� C.-_,i ididt�;'!' l..;
is ca be used to apply for the following perinits only (check ail thr
(interiol non-structural) L1 Electrical Alteration (not service change) EIG2sLighter
H,-,Ving Unit [A Lawn Spdrilder 0 IM -7 obile Home replacement 0 Roofing 0 Sevier Line 0 Phoilo-voltair,
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J—,,Zar FlaaLej- 0 Water Line 0 Wood/Pellet Stove (Must be EPA certified, provide in -aka w ic1
Vtwiilailon
prad
application. Incornplete applications will not be acce
al., Ep1j,",c�jbia Unionnation on'the aP
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(3 7 n�. Date
1-1a CJ 0 11 fill- - - ----%7--
I_70Tr7iC:, use only
VajLja 0fC,cnst3-u.cUon (labor, pirlil"f
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Job Al 0
1N C"JaiCity/State 7;
1.,cV Owner Nai6w Address
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Address CIL%//State Lip
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XZ211-t— report:? Ll 1 lere '1d'PC_'lVj1"!
Ft, Collins Sales Tax # Are you paying taxes here or by repo Ii'? t 1_1 1. ractor City of Are YOU paying with YOUr trust 21CCOUT V'yes .-I i%
wo Oar 1"7 raquil-ed bi, all con &actors.
esidu Itini 01. colpriercial project? Residential 0 Commercial
DrSingle Family Detached 0 Cando/townhorne (single F-cirrilly attached) Dupl.�'�
C1 Multifamily (apartment) 0 Garage
El I-lotel/Motel 0 Medical office 1-1 Office EJ Retail
D Church
ii commercial, is it: Cl Bank F3 Bar
0 Restaurant I-.] Other (explain)
a s f age or rnore? El Yes El No 1*f yes, you n7ay need to contact. I-11sturic Proserin, 17' it/
likill Ig so Nye Mon permit, what year was the building constructed?
it
mr a arno li t to submit with. this appliration.
I Q 71; •, III l'i4l need an asbestos assessn-ien
Ion of
wu-lit .,I)[ il lkler/huckflow iweventer, must list licensed plumber
If first -Lime A/C, must list licensed electridan.
Mechanical —
Roofer_- 01.1
:i--. T-V W1010WICNIge thatI have reactthis application and state that U-ie above information is complete and Corl'LCL.
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%-Ijit 11 Z-111 I-KNiremerits, contained herein and city ordinances and state laws regulating building consblld Oi . .1 knolm t.",
' pa2d and Issued.
nir I-.; ot valid L,;Id)as been
ir
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tSignature ate J